Perry opposition to 'Obamacare' tougher after election

Lt. Gov. David Dewhurst, left, Gov. Rick Perry and state Sen. Dan Patrick held a September news conference devoted to stricter spending limits in Texas.

Lt. Gov. David Dewhurst, left, Gov. Rick Perry and state Sen. Dan Patrick held a September news conference devoted to stricter spending limits in Texas.

Photo: Brett Coomer, Houston Chronicle

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Rep. Garnet Coleman, dist. 147

Rep. Garnet Coleman, dist. 147

Photo: handout

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Perry opposition to 'Obamacare' tougher after election

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Although Gov. Rick Perry still is resisting Texas' participation in the expansion of Medicaid and the creation of a state insurance exchange, the governor's word may not be the last word on these two key components of the Affordable Care Act.

Like other Republican governors who are having post-election second thoughts about their opposition to so-called Obama- care, Perry may find it difficult to ignore business owners, hospitals and other public officials who insist that consumers and the Texas economy benefit when Medicaid and health coverage is available to more people.

Under President Barack Obama's Affordable Care Act, citizens of every state will have access to a health-insurance exchange - essentially a competitive online marketplace designed to help consumers who aren't covered by employer-sponsored plans to pick the best insurance plan and price for their needs.

Perry all along planned to ignore a Friday deadline for states to declare their intentions to set up the exchange. The deadline has been pushed back to Dec. 14, but Perry hasn't changed his mind.

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"As the governor has made clear in the past, he has no interest in implementing a state exchange or expanding Medicaid, and he opposes both measures for Texas," spokeswoman Catherine Frazier said in a Thursday email.

If Texas doesn't create its own, the federal government will do it on its behalf. Either way, low-income Texans eligible for federal health insurance subsidies will be able to compare plans and buy insurance through an exchange. Consumers with incomes too high for subsidies could still benefit from exchange- inspired competition among insurers.

"The exchange is going to happen. That's 100 percent," said state Rep. Garnet Coleman, D-Houston.

'Election is over'

The exchanges are scheduled to begin running by Oct. 1, 2013, with coverage beginning in January 2014.

Coleman put Texas' odds at Medicaid expansion at 50-50.

Obama's re-election was a decisive factor in a softening of opposition to the two components, even in Texas, Coleman added. "A lot of states with Republican governors are not looking at exchanges and the expansion of Medicaid. We're going to see this change and change rapidly prior to the start of the legislative session and during the legislative session," he said.

So far, 17 states and the District of Columbia have indicated they will set up their own exchanges, with legislation pending in five states. Thirteen still are studying their options.

Perry and Florida Gov. Rick Scott have been among the most vociferous opponents of the Affordable Care Act, but Scott recently has signaled a willingness to reconsider.

"The election is over and President Obama won," the Republican governor told the Associated Press last week. "I'm responsible for the families of Florida. ... If I can get to yes, I want to get to yes."

Perry, however, continued to hold firm in his opposition to expanding Medicaid, even though the federal government would pay the entire cost of that coverage for the first three years and 90 percent after that. The governor has said Texas will not participate because of future costs to the state.

The Affordable Care Act calls for those who earn up to 133 percent of the federal poverty level - about $25,390 for a family of three - to qualify for Medicaid. In the past, Medicaid in Texas mainly covered very poor people over 65, as well as children and pregnant women.

Medicaid expansion will provide a cash infusion to the states of more than $900 billion in federal dollars from 2014 to 2022. An estimated $164 billion would go to Texas.

Where Texas stands

According to the U.S. Census Bureau, nearly 6.1 million Texans, 23.8 percent of the population, do not have health insurance, the highest percentage of any state.

Texas has the second-highest number of uninsured residents, 5.6 million children and adults, according to state and federal health officials. Expanding Medicaid would cover as many as 2 million currently uninsured and would represent the largest percentage increase of all the states.

More than a quarter of Harris County residents, 1,025,922, are uninsured. Medicaid expansion is projected to reduce that number to 570,484, or 13.9 percent.

"There's going to be a very vital conversation about it," said Anne Dunkelberg, associate director of the Center for Public Policy Priorities, an Austin-based think tank that supports Medicaid expansion. "When business people hear about the numbers involved, it's moving to the top of their list."

According to an analysis by the Perryman Group, a Waco-based economic analysis and research firm, every dollar that Texas spends to expand Medicaid coverage would return $1.29 to the state economy during the first 10 years of expansion.

Medicaid expansion "represents one of those rare occasions where Texas can both provide significant services for many of its least advantaged citizens while simultaneously stimulating the economy and taking the most fiscally responsible course," said Ray Perryman in a statement.

In Harris County

David Lopez, president and chief executive officer of the Harris Health System (formerly the Harris County Hospital District), noted that Medicaid expansion does not go into effect until January 2014. "That gives us about a year to figure something out," he said. "The Legislature may weigh in on this issue. Idealistically, it would be great if they could reason with the governor."

Lopez noted that Perry seems to have left the door at least slightly ajar for compromise by saying that he does not support Medicaid expansion the way it is currently operating.

"He may recommend changes in some of the rules and regulations, and those would allow him to participate," he said.

Lopez is concerned about a provision in the Affordable Care Act that phases out federal money hospitals receive to help them cover the costs of uncompensated care. If that money is reduced and if the state has spurned Medicaid expansion, then the burden of paying for the uninsured's health care falls even more heavily on county residents, whose property taxes support safety-net public institutions.

The system last year spent roughly $675 million caring for the uninsured.

Perry announced his opposition to the health care proposals in July, after the U.S. Supreme Court found the Affordable Care Act to be constitutional.

'Middle ground'

"The government is not just Rick Perry," said Coleman, who was in Washington, D.C., last week for talks with the Obama administration's Medicaid chief.

Coleman insisted the administration is open to discussions about reaching "a middle ground" through waivers, so Texas does not walk away from $150 billion over the next 10 years.